[Renal stenosis in hypertensive children. Doppler/arteriographic correlation].
To evaluate the reliability of Doppler-ultrasonography in identifying children with renal artery stenosis among those with hypertension, we compared Doppler ultrasonography results in 29 hypertensive children (mean age: 8.3 +/- 4.7 years) with angiography. Doppler-ultrasonography and arteriography were performed within a period less than two months. First, we established normal values in 40 normotensive children (mean age: 8.4 +/- 4.5 years). The diagnosis of renal artery stenosis was settled when maximal systolic velocities where > or = to 1.70 m.s-1. Peak systolic velocities values of Doppler-ultrasonography were significantly higher in patients with proven angiographic renal artery stenosis (3.56 +/- 0.70 m.s-1) than in hypertensive patients with normal renal arteries at angiography (1.02 +/- 0.29 m.s-1, p < 0.0001), and than in normotensive healthy children (1.05 +/- 0.33 m.s-1, p < 0.0001). We observed 3 false negative and 2 false positive diagnoses with Doppler-ultrasonography. Of the 3 false negatives, one had a stenosis on a right and posterior segmental artery and the other had bilateral and multiply intra-renal artery stenosis with few hemodynamic significance. The 2 false positives were due to a sinuous main renal artery and to a technical mistake, respectively. In another patient, Doppler-ultrasonography revealed a tight main renal artery stenosis, not detected by arteriography. Renal artery stenosis was subsequently confirmed by a second arteriography. Our results showed a sensitivity of 88%, a specificity of 93%, a positive predictive value of 92% and a negative predictive value of 89%, demonstrating the reliability of Doppler-ultrasonography for the diagnosis of renal artery stenosis in hypertensive children. With the use of a rigorous methodology and the increasing experience of the operators, diagnostic errors of renal artery stenosis are currently avoidable. Nevertheless, it is not excluded that intra-renal artery stenosis with few hemodynamic significance might be missed by Doppler-ultrasonography.
Kchouk
H
H
Service d'explorations fonctionnelles, Hôpital Robert Debré, Paris.
Brun
P
P
Sentou
Y
Y
Raynaud
A
A
Gaux
J C
JC
Loirat
C
C
D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D008297:Male; D011237:Predictive Value of Tests; D011859:Radiography; D012078:Renal Artery Obstruction / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler
Sténoses rénales chez les enfants hypertendus. Corrélation Doppler/arteriographie.